Recent Submissions

  • Psychopathy in women: insights from neuroscience and ways forward for research

    Tully, John (2021)
    Suicide rates among adolescents and young adults have been increasing in the last decade. The current knowledge of the warning signs, risk factors, and the use of screening tools has many gaps. There are many views from within, critics, survivors, and advocacy groups to focus more on the contextual understanding of symptomatology. In clinical practice, many of these high-risk groups fail to raise the red flags due to the complex and ambigious nature of presentations. Therefore, these groups need greater attention, and given their counterinitiative nature they challenge the current approaches to address suicidality in adolescents and yound adults.
  • Associations between personal recovery and service user-rated versus clinician-rated clinical recovery, a cross-sectional study

    Slade, Mike (2022)
    BACKGROUNDThis study examined the relationship between service user-rated personal recovery and clinician-rated and service user-rated clinical recovery. The relationships between different subdomains of clinical recovery and personal recovery were also assessed.METHODSIn total, 318 mental health service users with a psychosis diagnosis and their clinicians from 39 sites across Norway completed standardized questionnaires regarding personal recovery, clinical symptoms and psychosocial functioning. Regression models were used to investigate the relationship between personal and clinical recovery.RESULTSOverall, clinical recovery was positively associated with personal recovery, when rated both by service users and by clinicians. Personal recovery was associated with lower levels of depression, self-harm and problems with relationships when rated by the service users. Among the subdomains rated by the clinicians, personal recovery was associated with fewer problems with relationships and higher aggressiveness.CONCLUSIONSThese findings suggest that affective symptoms are associated with personal recovery, indicating the need for greater focus on depression treatment among people with psychosis. Improving social connections is of importance for personal recovery, and might be an area where clinicians and service users can meet and find agreement on important treatment goals.
  • Positive psychotherapy for psychosis in Hong Kong: A randomized controlled trial

    Slade, Mike (2022)
    Recovery-oriented practice has been advocated in mental health services in Hong Kong since 2009. Well-being has become an important area of focus for mental health services. Positive Psychotherapy for Psychosis (PPP) is a well-being-focused intervention for use in psychosis, with preliminary evidence from a randomized controlled trial in the United Kingdom of impact on well-being and symptomatology. The aim of this study was to test the effectiveness of PPP on the well-being of people with psychosis in Hong Kong. The study was a randomized controlled trial with two-arm parallel groups. Both groups received treatments as usual, and in addition the intervention group received a 13-session intervention based on a Cantonese Chinese translation of the PPP manual. Intention-to-treat analysis was used. The trial was registered (ANZCTR: ACTRN12620000464965). A total of 154 participants (78 intervention, 76 control) were recruited. As compared to control group, intervention group participants showed significant changes over time on the primary outcome of well-being assessed using the Chinese Short Warwick-Edinburgh Mental Well-being Scale (p = 0.001) and on secondary outcomes of hope (Agency subscale: p = 0.029) and self-efficacy (p = 0.001). Positive Psychotherapy for Psychosis was found to be an effective treatment in improving the well-being and other mental health outcomes for people with psychosis. It can be recommended for use in mental health services to promote recovery.
  • How do recorded mental health recovery narratives create connection and improve hopefulness?

    Ng, Fiona; Newby, Christopher; Llewellyn-Beardsley, Joy; Yeo, Caroline; Rennick-Egglestone, Stefan; Slade, Mike (2022)
    BACKGROUNDMental health recovery narratives are an active ingredient of recovery-oriented interventions such as peer support. Recovery narratives can create connection and hope, but there is limited evidence on the predictors of impact.AIMSThe aim of this study was to identify characteristics of the narrator, narrative content and participant which predict the short-term impact of recovery narratives on participants.METHODIndependent studies were conducted in an experimental (n = 40) and a clinical setting (n = 13). In both studies, participants with mental health problems received recorded recovery narratives and rated impact on hopefulness and connection. Predictive characteristics were identified using multi-level modelling.RESULTSThe experimental study found that narratives portraying a narrator as living well with mental health problems that is intermediate between no and full recovery, generated higher self-rated levels of hopefulness. Participants from ethnic minority backgrounds had lower levels of connection with narrators compared to participants from a white background, potentially due to reduced visibility of a narrator's diversity characteristics.CONCLUSIONSNarratives describing partial but not complete recovery and matching on ethnicity may lead to a higher impact. Having access to narratives portraying a range of narrator characteristics to maximise the possibility of a beneficial impact on connection and hopefulness.
  • INCRESE: Development of an inventory to characterize recorded mental health recovery narratives

    Llewellyn-Beardsley, Joy; Rennick-Egglestone, Stefan; Ng, Fiona; Hui, Ada; Deakin, Emilia; Hare-Duke, Laurie; Slade, Mike (2020)
    ObjectiveMental health recovery narratives are increasingly used in clinical practice, public health campaigns, and as directly-accessed online resources. No instrument exists to describe characteristics of individual recovery narratives. The aims were to develop and evaluate an inventory to characterize recorded recovery narratives.Research Design and MethodsA preliminary version of the Inventory of Characteristics of Recovery Stories (INCRESE) was generated from an existing theory-base. Feasibility and acceptability were evaluated by two coders each rating 30 purposively-selected narratives. A refined version was produced and a formal evaluation conducted. Reliability was assessed by four coders each rating 95 purposively-selected narratives. Inter-coder reliability was assessed using Fleiss's kappa coefficients; test-retest reliability was assessed using intra-class correlation coefficients (ICCs).ResultsMultiple refinements to description, coding categories, and language were made. Data completeness was high, and no floor or ceiling effects were found. Intercoder reliability ranged from moderate (k=0.58) to perfect (k=1.00) agreement. Test-retest reliability ranged from moderate (ICC=0.57) to complete (ICC=1.00) agreement. The final INCRESE comprises 77 items spanning five sections: Narrative Eligibility; Narrative Mode; Narrator Characteristics; Narrative Characteristics; Narrative Content.ConclusionINCRESE is the first evaluated tool to characterize mental health recovery narratives. It addresses current concerns around normative recovery narratives being used to promote compulsory wellness, e.g. by identifying narratives that reject diagnosis as an explanatory model and those with non-upward trajectories. INCRESE can be used to establish the diversity of a narrative collection and will be used in the NEON trials (ISRCTN11152837, ISRCTN63197153, ISRCTN76355273) to allow a recommender system to match narratives to participants.
  • Achieving Quality and Effectiveness in Dementia Using Crisis Teams (AQUEDUCT): a study protocol for a randomised controlled trial of a Resource Kit

    Coleston-Shields, Donna M.; Challis, David; Worden, Angela; Broome, Emma; Dening, Tom; Guo, Boliang; Prothero, David; Orrell, Martin (2022)
    Improving care at home for people with dementia is a core policy goal in the dementia strategies of many European countries. A challenge to effective home support is the occurrence of crises in the care of people with dementia which arise from changes in their health and social circumstances. Improving the management of these crises may prevent hospital admissions and facilitate better and longer care at home. This trial is part of a National Institute for Health Research funded programme, AQUEDUCT, which aims to improve the quality and effectiveness of teams working to manage crises in dementia.
  • Exploring the experiences of parents whose child has received a diagnosis of autistic spectrum disorder in adulthood

    Gillott, Alinda (2022)
    There is a growing trend of adult diagnosis of Autism Spectrum Disorder (ASD). Research has found that diagnosis can prompt a process of sense-making which may be disrupted by lack of post-diagnostic support. Given the continued involvement of many parents in supporting their adult son or daughter with ASD, it is vital to understand their experiences to meet their needs in adapting to the diagnosis. Eleven parents of recently diagnosed adults participated in semi-structured interviews which were analysed thematically. Findings demonstrate that the new knowledge of diagnosis facilitates changes in attributions, interactions and relationships, but can result in unmet emotional and relational support needs. Findings are relevant to those involved in adult diagnosis, and the provision of post-diagnostic support.
  • The feasibility of a strategy for the remote recruitment, consenting and assessment of recent referrals: a protocol for phase 1 of the On-Line Parent Training for the Initial Management of ADHD referrals (OPTIMA)

    Daley, David; French, Blandine; Glazebrook, Cris; Groom, Madeleine J.; Hall, Charlotte L.; Sayal, Kapil (2022)
    BACKGROUND: In the UK, children with high levels of hyperactivity, impulsivity and inattention referred to clinical services with possible attention-deficit/hyperactivity disorder (ADHD) often wait a long time for specialist diagnostic assessment. Parent training (PT) has the potential to support parents during this difficult period, especially regarding the management of challenging and disruptive behaviours that often accompany ADHD. However, traditional face-to-face PT is costly and difficult to organise in a timely way. We have created a low-cost, easily accessible PT programme delivered via a phone app, Structured E-Parenting Support (STEPS), to address this problem. The overall OPTIMA programme will evaluate the efficacy and cost-effectiveness of STEPS as a way of helping parents manage their children behaviour while on the waitlist. To ensure the timely and efficient evaluation of STEPS in OPTIMA, we have worked with children's health services to implement a remote strategy for recruitment, screening and assessment of recently referred families. Part of this strategy is incorporated into routine clinical practice and part is OPTIMA specific. Here, we present the protocol for Phase 1 of OPTIMA-a study of the feasibility of this remote strategy, as a basis for a large-scale STEPS randomised controlled trial (RCT). METHODS: This is a single arm observational feasibility study. Participants will be parents of up to 100 children aged 5-11 years with high levels of hyperactivity/impulsivity, inattention and challenging behaviour who are waiting for assessment in one of five UK child and adolescent mental health or behavioural services. Recruitment, consenting and data collection will occur remotely. The primary outcome will be the rate at which the families, who meet inclusion criteria, agree in principle to take part in a full STEPS RCT. Secondary outcomes include acceptability of remote consenting and online data collection procedures; the feasibility of collecting teacher data remotely within the required timeframe, and technical difficulties with completing online questionnaires. All parents in the study will receive access to STEPS. DISCUSSION: Establishing the feasibility of our remote recruitment, consenting and assessment strategy is a pre-requisite for the full trial of OPTIMA. It can also provide a model for future trials conducted remotely.
  • Clinicians' perspectives on supporting individuals with severe anorexia nervosa in specialist eating disorder intensive treatment settings

    Arcelus, Jon (2022)
    BACKGROUND: Admissions to intensive treatment (i.e., inpatient [IP] and/or day patient [DP]) for individuals with severe anorexia nervosa (AN) are common. Growing literature indicates potential risks and benefits of each intensive treatment approach; however, existing research has focused on patient and carer perspectives of these treatments. Also, there is scant empirical evidence available for guiding the parameters of intensive treatments for AN. We therefore explored clinicians' perspectives and experience of supporting adults with severe AN in intensive settings. METHODS: We conducted twenty one semi-structured interviews with clinicians who deliver intensive treatments (i.e., IP and/or DP) for individuals with severe AN across four specialist Eating Disorder Services in the United Kingdom between May 2020 and June 2021. We asked clinicians about their views and experiences of supporting individuals with severe AN in intensive treatment settings and the challenges and opportunities associated with IP and DP treatment. Data were analysed using reflexive thematic analysis supported by NVivo software. RESULTS: Five broad and interrelated themes were identified: (1) Intensive Support; (2) The Severity of Patients' Illnesses; (3) Hope and Recovery; (4) Which Treatment When; (5) Limited Resources; and (6) Carer Burden. We identified various similarities between the two intensive treatment approaches, including the value of intensive and multidisciplinary support and carer involvement, and the challenge of managing complex and unique needs in resource-limited intensive settings. We also found differences in the relationship of treatment to patients' home environments, the necessity of patient motivation, and the management of risk. CONCLUSIONS: Both intensive treatment settings are valued by clinicians; however, there are unique challenges and opportunities for supporting individuals with severe AN within each. Our findings suggest DP treatment may be used as an alternative to IP treatment for individuals with severe AN. However, clear questions remain over which intensive treatment setting is best suited to which patient when and should be the focus of future research. Some people with anorexia nervosa will need intensive treatment (e.g., inpatient and day patient treatment) during the course of their illness. We interviewed twenty-one clinicians working in Specialist Eating Disorder Services to explore their views on supporting people with severe anorexia nervosa in inpatient and day patient services and about the perceived advantages and disadvantages of these. We analysed the transcripts of these interviews using thematic analysis. We identified similarities between the two intensive treatment approaches. These included the value of intensive and multidisciplinary support, the importance of carer involvement, and the challenge of managing patient’s complex and unique needs in services with limited resources. We also found differences between inpatient and day patient treatment. These included how treatment relates to patients’ home environments, the importance of patient motivation, and managing risk. Day patient treatment may be an alternative to inpatient treatment for people with severe anorexia nervosa. Future research should investigate which intensive treatment setting is best suited to which patient and when.
  • This is Me: Evaluation of a boardgame to promote social engagement, wellbeing and agency in people with dementia through mindful life-storytelling

    Craven, Michael P.; Gosling, Julie (2022)
    Receiving a dementia diagnosis is a difficult experience for most people and often affects their wellbeing negatively. To support people's wellbeing, in a therapeutic context, life-storytelling, reminiscence and mindfulness are used with people with dementia. In an everyday context, traditional games are used as a resource for stimulating memory, cognition and social activity. While an increasing number of creative strategies are available to support people with dementia, the area of board games design and their effect on wellbeing is underexplored. This paper reports on the evaluation of the This is Me (TIM) mindful life-storytelling board game by the European project MinD. Using a co-design methodology, TIM was developed with and for people with mild to moderate dementia to support their wellbeing by enhancing self-empowerment and social engagement. A focus group methodology was used to evaluate TIM with 50 people with dementia and 19 carers across four countries. TIM was evaluated with regard to the usability and experience of the design as well as people's emotional wellbeing, social engagement and agency. The thematic analysis demonstrated that the combination of life-storytelling and mindfulness allowed players to engage in meaningful social interaction and, as a result, they reported enjoyment, learning, more acceptance of the past and present situation, and that they perceived looking forward into the future together with others as helpful. The study demonstrates that design can be a useful means to support people with dementia in aspects of emotional wellbeing, social engagement and a sense of agency.
  • Characterization of hemodynamic alterations in schizophrenia and bipolar disorder and their effect on resting-state fMRI functional connectivity

    Liddle, Peter F. (2021)
    Common and distinct neural bases of Schizophrenia (SZ) and bipolar disorder (BP) have been explored using resting-state fMRI (rs-fMRI) functional connectivity (FC). However, fMRI is an indirect measure of neural activity, which is a convolution of the hemodynamic response function (HRF) and latent neural activity. The HRF, which models neurovascular coupling, varies across the brain within and across individuals, and is altered in many psychiatric disorders. Given this background, this study had three aims: quantifying HRF aberrations in SZ and BP, measuring the impact of such HRF aberrations on FC group differences, and exploring the genetic basis of HRF aberrations. We estimated voxel-level HRFs by deconvolving rs-fMRI data obtained from SZ (N = 38), BP (N = 19), and matched healthy controls (N = 35). We identified HRF group differences (P < .05, FDR corrected) in many regions previously implicated in SZ/BP, with mediodorsal, habenular, and central lateral nuclei of the thalamus exhibiting HRF differences in all pairwise group comparisons. Thalamus seed-based FC analysis revealed that ignoring HRF variability results in false-positive and false-negative FC group differences, especially in insula, superior frontal, and lingual gyri. HRF was associated with DRD2 gene expression (P < .05, 1.62 < |Z| < 2.0), as well as with medication dose (P < .05, 1.75 < |Z| < 3.25). In this first study to report HRF aberrations in SZ and BP, we report the possible modulatory effect of dopaminergic signalling on HRF, and the impact that HRF variability can have on FC studies in clinical samples. To mitigate the impact of HRF variability on FC group differences, we suggest deconvolution during data preprocessing.
  • Are dental-related psychological variables important for dental attendance in China? A cross-sectional study

    Topcu, Gogem (2021)
    OBJECTIVEDental services are expanding in China, yet there is little evidence available on the dental-related psychological factors contributing to the uptake of dental services. Our study explored whether beliefs, anxiety, and cognitions significantly differ across different levels of attendance, and whether dental-related psychological variables can independently predict dental attendance in Chinese adults. We also explored the extent to which cognitions and beliefs relate to attendance as a function of dental anxiety.METHODIn our cross-sectional study 480 adult participants in China completed a questionnaire including dental attendance and measures of dental-related psychological variables (dental cognitions, beliefs, anxiety, and fear of dental pain).RESULTSOnly 25.8% of participants visited the dentist regularly. There was a significant difference for all dental-related psychological variables (p < 0.001), across all three levels of dental attendance (never; irregularly or regularly attend). Thus, fear of dental pain and dental anxiety are higher, and cognitions and beliefs are more negative, for those who have less favorable dental service utilization. All these variables, except fear of dental pain, were also independent predictors of dental attendance (p < 0.05). Moreover, how individuals think, and what they believe, about the dentist (and the dental context) were only partially explained through dental anxiety. Thus, beliefs (β = 0.579, SE = 0.035, p < 0.001) and cognitions (β = 0.594, SE = 0.045, p < 0.001) are impacting on dental attendance, mostly independent of whether the individual is anxious.CONCLUSIONOur preliminary findings show dental-related psychological factors are related to dental attendance and these should be explored further in a larger sample.
  • "I don't want to take buprenorphine for the rest of my life": Acceptance and commitment therapy for a client struggling to reduce low-dose buprenorphine (a hermeneutic single-case efficacy design)

    Prity, Beth; Tickle, Anna C. (2021)
    The misuse of substances is often maintained by both physical and psychological factors. Opioid-substitution medications manage physical aspects of addiction; however, difficulties with emotional regulation and avoidance perpetuate continued substance misuse. In the UK, individuals who misuse substances are often excluded from mental health services, meaning these underlying difficulties are not addressed. Acceptance and Commitment Therapy (ACT) seeks to reduce emotional avoidance. A hermeneutic single-case efficacy design was used to evaluate the effects of ACT within drugs and alcohol service. Quantitative and qualitative data was critically analysed to understand factors involved in identified changes. Analysis recognised the client progressed towards two of three of their goals, related to motivation and anxiety. Their psychological flexibility also increased. ACT processes played a key role in this; however, the therapeutic relationship and psychopharmacological factors were also noted. Study limitations and clinical and research implications are discussed.
  • Primary care depression advice clinic

    Ludvigsen, Anna; Nixon, Neil L. (2019)
    Aims and Objectives: The aim of the Depression Advice Clinic (DAC) was to provide timely specialist advice on depression management within a primary care setting for individuals suffering from treatment resistant or recurrent depression. Method(s): The clinic was located in a primary care centre and offered one-off 90 minute assessments to patients referred by their GPs. Patients were seen by a senior psychiatry trainee who conducted a comprehensive psychiatric history, examination, diagnosis and bio-psycho-social formulation. Following discussion with the supervising consultant psychiatrist a letter with recommendations for next step treatments was sent to patient and their GP. The clinic employed one full time senior trainee, a consultant psychiatrist at 12.5% full time equivalent and an administrator at 25% full time equivalent as well as incurring overheads for consultation room rental. Result(s): During the 12 month operational period 127 referrals were received and 124 assessment appointments were offered. The mean wait for assessment was 23 days (in secondary care this is closer to 70 days) and the completed assessment rate was 92% (in local audit of secondary care services this was 81%). Following initial assessment 96% patients were discharged to their GP with advice on lifestyle, self-care and next step pharmacological and psychotherapeutic management option. 4% of patients were transferred directly to secondary/ tertiary care psychiatry, for reasons including severity, risk or initiation of medications that could not be carried out in primary care (e.g. Lithium). Discussion(s): The DAC achieved its aim of providing timely assessment and advice for people suffering from persistent or recurrent depression with most patients being seen much sooner than they would have had they been referred to secondary care. There were also some surprising, and potentially significant, findings from the clinic: more men were referred to the clinic than would have been expected to be seen in secondary services and one third of patients referred with an existing diagnosis of depression had this diagnosis changed following assessment (primarily to one of the anxiety disorders). Each of the patients referred from the DAC into secondary and tertiary care disclosed that they had made plans to end their life which they had concealed form their families and GPs and that being seen in the clinic had prevented them from acting on their plans. Conclusion(s): Referral rates, completed appointment rates and stakeholder feedback suggest that the DAC was an operationally feasible way of working across primary, secondary and tertiary care, whilst also being acceptable to GPs and patients. It is estimated that the average cost per completed suicide for those of working age in England is 1.67m. Since at least three patients reported that being seen in the clinic had prevented them from ending their lives the DAC was also a cost effective way of decreasing the mortality and morbidity resulting from chronic and recurring depression.
  • Depressive symptoms, social support, and health-related quality of life: A community-based study in Shanghai, China

    Crawford, Paul; Kane, Eddie (2021)
    BACKGROUNDDepressive symptoms erode both physical and mental aspects of health-related quality of life (HRQoL). Social support (SS) may improve HRQoL through its direct effects or buffering effects. The association among depressive symptoms, SS, and HRQoL has been studied in specific groups, but research in the general adult population remains limited. This study examined the association among depressive symptoms, SS, and HRQoL, including exploring whether SS (including its three dimensions: subjective SS, objective SS and support utilization) mediated or moderated the relationship between depressive symptoms and HRQoL among community-based adults.METHODSWe conducted a cross-sectional survey in six communities in Shanghai, China, and 1642 adult participants with complete information on depressive symptoms and/or SS, and HRQoL were included. Linear regression analysis was used to investigate the association among depressive symptoms, SS, and HRQoL. In addition, we explored the mediating and moderating role of SS in the relationship between depressive symptoms and HRQoL.RESULTSMore depressive symptoms were associated with lower physical HRQoL (B = -0.64, p < .001) and lower mental HRQoL (B = -0.83, p < .001). SS (B = 0.07, p = .02), specifically subjective SS (B = 0.09, p = .03), was positively related to mental HRQoL. After adjusting for covariates, we found no evidence for a mediating role of SS in the relationship between depressive symptoms and HRQoL, while SS (subjective SS and objective SS) moderated the association between depressive symptoms and mental HRQoL.LIMITATIONSDue to the low voluntary participation rate of employees, participants represented approximately 50% of the individuals approached, thus limiting the generalizability of our findings. Data collected through self-report scales could lead to information bias.CONCLUSIONSSS does not appear to underlie the relationship between depressive symptoms and HRQoL. However, interventions to increase SS (in particular, subjective SS and objective SS) should be studied to determine whether they may be beneficial in alleviating the adverse impact of depressive symptoms on mental HRQoL.
  • The extent of user involvement in the design of self-tracking technology for bipolar disorder: Literature review

    Brown, Susan S.; Lang, Alexandra; Moore, Matthew; Morriss, Richard K. (2021)
    BACKGROUNDThe number of self-monitoring apps for bipolar disorder (BD) is increasing. The involvement of users in human-computer interaction (HCI) research has a long history and is becoming a core concern for designers working in this space. The application of models of involvement, such as user-centered design, is becoming standardized to optimize the reach, adoption, and sustained use of this type of technology.OBJECTIVEThis paper aims to examine the current ways in which users are involved in the design and evaluation of self-monitoring apps for BD by investigating 3 specific questions: are users involved in the design and evaluation of technology? If so, how does this happen? And what are the best practice ingredients regarding the design of mental health technology?METHODSWe reviewed the available literature on self-tracking technology for BD and make an overall assessment of the level of user involvement in design. The findings were reviewed by an expert panel, including an individual with lived experience of BD, to form best practice ingredients for the design of mental health technology. This combines the existing practices of patient and public involvement and HCI to evolve from the generic guidelines of user-centered design and to those that are tailored toward mental health technology.RESULTSFor the first question, it was found that out of the 11 novel smartphone apps included in this review, 4 (36%) self-monitoring apps were classified as having no mention of user involvement in design, 1 (9%) self-monitoring app was classified as having low user involvement, 4 (36%) self-monitoring apps were classified as having medium user involvement, and 2 (18%) self-monitoring apps were classified as having high user involvement. For the second question, it was found that despite the presence of extant approaches for the involvement of the user in the process of design and evaluation, there is large variability in whether the user is involved, how they are involved, and to what extent there is a reported emphasis on the voice of the user, which is the ultimate aim of such design approaches. For the third question, it is recommended that users are involved in all stages of design with the ultimate goal of empowering and creating empathy for the user.CONCLUSIONSUsers should be involved early in the design process, and this should not just be limited to the design itself, but also to associated research ensuring end-to-end involvement. Communities in health care-based design and HCI design need to work together to increase awareness of the different methods available and to encourage the use and mixing of the methods as well as establish better mechanisms to reach the target user group. Future research using systematic literature search methods should explore this further.
  • Post-traumatic growth in psychosis: a systematic review and narrative synthesis

    Ng, Fiona; Rennick-Egglestone, Stefan; Newby, Christopher; Hare-Duke, Laurie; Llewellyn-Beardsley, Joy; Yeo, Caroline; Slade, Mike (2021)
    BACKGROUND AND OBJECTIVEPeople with psychosis report experiences of highly traumatic events. Positive change or post-traumatic growth (PTG) can occur as a result of traumatic experiences. Yet there is limited attention on PTG in psychosis, possibly due to the negative impact of psychotic symptoms on functioning and quality of life. The aim of this review was to identify significant correlates and mediators of PTG in psychosis, and to develop a conceptual framework synthesising facilitators of PTG in psychosis.METHODTen electronic databases were searched in seven languages, and five journals and grey literature were searched in English. Quantitative studies were eligible if examining correlates, mediators, or the temporal relationship between PTG and one or more variables. Qualitative studies were eligible if describing PTG arising from experiences of psychosis. Findings from quantitative papers were grouped by analysis method, with significant correlates, mediators, and temporal relationships descriptively reported upon. Narrative synthesis was conducted on findings in qualitative papers.RESULTSThirty-seven papers were included. Significant correlates and mediators of PTG were identified. Mediators of PTG in psychosis included meaning in life, coping self-efficacy, core beliefs, and self-reported recovery. No studies describing the temporal relationship between PTG and psychosis were identified. The narrative synthesis identified seven facilitators of PTG in psychosis: Personal identity and strength, Receiving support, Opportunities and possibilities, Strategies for coping, Perspective shift, Emotional experience, and Relationships, giving the acronym PROSPER.CONCLUSIONSIndividuals with psychosis can be supported to grow from traumatic experiences. Clinicians can support PTG through the provision of trauma-informed care that supports positively valued identity changes. For researchers, the findings provide an evidence-based theoretical framework for conceptualising PTG, which can be validated through longitudinal cohort studies and underpin the development of new clinical interventions.
  • Multicentre randomised controlled trial of a group psychological intervention for postnatal depression in British mothers of South Asian origin (ROSHNI-2): study protocol

    Morriss, Richard K. (2022)
    Background In the UK, postnatal depression is more common in British South Asian women than White Caucasion women. Cognitive–behavioural therapy (CBT) is recommended as a first-line treatment, but there is little evidence for the adaptation of CBT for postnatal depression to ensure its applicability to different ethnic groups. Aims To evaluate the clinical and cost-effectiveness of a CBT-based positive health programme group intervention in British South Asian women with postnatal depression. Method We have designed a multicentre, two-arm, partially nested, randomised controlled trial with 4- and 12-month follow-up, comparing a 12-session group CBT-based intervention (positive health programme) plus treatment as usual with treatment as usual alone, for British South Asian women with postnatal depression. Participants will be recruited from primary care and appropriate community venues in areas of high South Asian density across the UK. It has been estimated that randomising 720 participants (360 into each group) will be sufficient to detect a clinically important difference between a 55% recovery rate in the intervention group and a 40% recovery rate in the treatment-as-usual group. An economic analysis will estimate the cost-effectiveness of the positive health programme. A qualitative process evaluation will explore barriers and enablers to study participation and examine the acceptability and impact of the programme from the perspective of British South Asian women and other key stakeholders.
  • How effective is group intervention in the treatment of unaccompanied and accompanied refugee minors with mental health difficulties: A systematic review

    Majumder, Pallab (2021)
    Background:Unaccompanied refugee minors (URM) are at significantly higher risk of trauma exposure and mental illness. Research examining the most effective treatments for this population is limited.Aims:To study the available research evidence on outcomes from various group interventions in this population. The objective is to investigate if these can be used clinically in future interventions.Methods:Systematic review was carried out for patient outcomes where group therapy was used as treatment in URM. Studies with ARM (Accompanied refugee minors) were included because of similarities between these groups and because many studies were mixed population.Results:Seventeen papers met eligibility criteria with a total of N?=?1,119 participants. About 80% studies with a quantitative component reported improvements, and 69% of the studies that carried out statistical analyses reported statistically significant improvements in mental health symptoms. Every qualitative measure reported positive outcome for the participants. Studies with URM tended to show improved outcomes more often than studies exclusively with ARM.Conclusions:The evidence demonstrates the efficacy of group therapy in improving mental health outcomes, although the number of studies with robust methodology is small. Group intervention has potential to improve engagement and outcomes of URM with mental illness. Future direction for research is discussed.
  • The struggle of apathy in dementia

    Dening, Tom; Baber, Waqaar; Chang, Marybeth; Yates, Jennifer A. (2021)
    Most people will recognise a sense of apathy within them, at some point during their lives, and this may present to a greater or lesser extent depending on the individual and the context. When people are asked about what apathy is, what it means, or how it might feel, generally they can provide an insight, suggesting it is something broadly universal to the human experience. We might consider apathy to be a lack of motivation, a feeling of not being bothered, or a desire to do something coupled completely with a desire not to do that same thing. For most people though, apathy can be overcome, and it represents a fleeting problem that does not impact on day-to-day life. For people with dementia, apathy is an important problem because it is recognised anecdotally, clinically and in research to be common (Selbaek et al., 2013; Zhao et al., 2016), persistent (van der Linde et al., 2017), and difficult to live with for both the person with dementia and those close to them (Feast et al., 2016). Follow-up studies suggest that apathy is associated with worse health and social outcomes (Breitve et al., 2018).

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